Abstract
Objectives: The following questions were addressed; to what extent is sugar consumption, tooth brushing, and oral health related attitudes and knowledge subject to change following a combined atraumatic restorative treatment (ART) /oral health education (OHE) program? Are changes in intended sugar avoidance associated with changes in cognitions as specified by the Theory of Planned Behaviour (TPB)? Are changes in oral health related knowledge associated with changes in attitudes and oral health behaviour?Method: A total of 1306 (follow-up prevalence 73.8%) primary school students in Kilwa, Tanzania completed interviews before and after a combined ART/OHE program. Post intervention at 6 months follow-up assessed changes in oral health related knowledge, attitudes, and behaviours. Complete baseline and follow-up interviews were obtained from 221 and 1085 students who received ART/OHE and OHE only at schools, respectively.Results: Improvement was obtained with attitudes towards sugar avoidance, knowledge, and tooth brushing (effect sizes in the range 0.1-0.3). Within individual changes did not differ significantly between students receiving ART/ OHE and OHE only. Change scores of intended sugar avoidance associated in the expected direction with changes in sugar consumption. Attitudes and norms with respect to sugar avoidance deteriorated and improved among subjects who respectively decreased and increased intended sugar avoidance. Tooth brushing increased in students who improved oral knowledge.Conclusion: School based ART/OHE improved pupils’ tooth brushing, knowledge, and attitudes, but had no effect on sugar consumption. This study provided support for the validity of the TPB in predicting changes in intended sugar avoidance and reported sugar intake.
Highlights
In Tanzania, dental diseases have remained at moderate levels, as approximately 30-40% of the population irrespective of age, is reportedly free from dental caries [1]
The following questions were addressed: To what extent is the Theory of Planned Behaviour (TPB) constructs, sugar consumption, tooth brushing and oral health related knowledge subject to change following a combined atraumatic restorative treatment (ART)/oral health education (OHE) program? Are observed changes in intention to avoid sugared snacks associated with changes in attitudes, subjective norms and perceived control and with reported sugar consumption as specified by the TPB? This study explored whether changes in oral health related knowledge associated with changes in attitudes towards sugar avoidance, tooth brushing frequency, and reported sugar consumption
This study has shown that a combined intervention of ART and OHE implemented by oral health care staff and teachers in primary school, improved students’ oral health related knowledge, attitudes towards sugar avoidance, and tooth brushing frequency, but had no effect on their motivation to avoid sugared snacks and their self-reported level of sugar consumption
Summary
In Tanzania, dental diseases have remained at moderate levels, as approximately 30-40% of the population irrespective of age, is reportedly free from dental caries [1]. The exposure to dental health care services has been low with a dentist to population ratio of 1:347,273 [7,8]. To compensate for the limited number of dental professionals and to make dental care available for the youth population, ART and oral health education, OHE, have been recommended. According to the World Health Organization (WHO), the ART is recognized to be appropriate for public oral health care services in developing countries [9,10]. This approach has been introduced in three regions of Tanzania [10]
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